Poststreptococcal Disorder

Post-streptococcal disorder (PSD) is actually a group of autoimmune disorders. An autoimmune disorder occurs when your own body’s immune system begins to mistakenly attack your own organs. PSD affects the central nervous system or other organs and is caused by Streptococcus pyogenes, also known as group A streptococcus (GAS). Post-streptococcal disorder can cause problems with the heart and joints, and can also cause psychiatric and sleep disorders.

PSD is caused by group A streptococcus (GAS). GAS is a type of bacterium that is found on the skin or in the throat. If you have GAS, you may not experience any symptoms. If you do experience symptoms, the most common are:

• strep throat—swollen tonsils covered in a white coating, swollen and tender lymph nodes, low-grade fever, headache, and pain when swallowing
• scarlet fever—sore throat, red skin rash, and reddened tongue
• impetigo—an skin infection with open sores, fever, sore throat, and swollen lymph nodes

When PSD affects the central nervous system, symptoms may include behavioral changes, such as:

• confusion
• anxiety
• disorientation
• aggression

PSD can also lead to negative emotional changes such as:

• hopelessness
• fear
• sadness
• despair
• agitation

PSD can cause you to have the symptoms of obsessive compulsive disorder—a type of anxiety disorder that causes people to experience repeated and undesirable thoughts, ideas, feelings, or behaviors that make them feel a compulsion to do something, such as counting and arranging things, hoarding things, or repeatedly checking things

PSD has also been known to lead to chorea—which causes spontaneous, rapid jerking movements.

GAS can also cause post-streptococcal glomerulonephritis. This is a disorder of the kidneys that can occur at any age, but is most common in children between 6 and 10 years of age. Symptoms include: 

• decreased output of urine
• rust-colored urine
• swelling of the eyes or face
• swelling of the abdomen
• swelling of the feet, ankles, or hands
• blood in the urine
• joint stiffness or swelling
• joint pain

Your doctor will make a diagnosis of PSD based upon your signs and symptoms.

If your doctor suspects you or your child is suffering from post-streptococcal glomerulonephritis (GN), he or she may recommend the following tests:

• urinalysis—a chemical and microscopic analysis of urine
• anti-DNase B—a blood test to detect antibodies to group A streptococcus
• serum ASO—a blood test to measure antibodies against streptolysin O, a product of group A streptococcus
• serum complement levels—a test to measure proteins in your blood
• kidney biopsy (this is rarely needed)

There is no cure or even medication that directly addresses PSD. Instead, treatment is focused on relieving symptoms and limiting your long- term risk for complications.

For emotional disorders and behavioral changes, treatment may include:

• therapy
• anti-anxiety medications
• antidepressants
• sedatives

Obsessive-compulsive disorder is treated using a combination of medication and therapy. Your doctor may prescribe an antidepressant known as a selective serotonin reuptake inhibitor (SSRI). SSRIs include:

• fluoxetine (Prozac)

• citalopram (Celexa)
• fluvoxamine (Luvox)

• sertraline (Zoloft)
• paroxetine (Paxil)

Your doctor may also prescribe:

• neuroleptic medications or dopamine-depleting agents to treat chorea
• antibiotics to kill any streptococcal bacteria remaining in your system
• blood pressure and diuretic medications to control high blood pressure and swelling

Your doctor may recommend that you reduce your salt intake to reduce swelling and lower blood pressure.

The outlook for PSD depends on which parts of the body it affects. Disorders of the central nervous system may be managed with the right combination of medication and psychotherapy. There is no specific treatment for post-streptococcal glomerulonephritis. However, your doctor will help you manage your symptoms, and the disorder generally will improve within a few weeks to several months.

Possible complications linked to post-streptococcal GN include:

• acute kidney failure
• chronic kidney disease
• chronic glomerulonephritis
• congestive heart failure
• end-stage renal disease
• high blood pressure
• nephrotic syndrome—the presence of protein in your urine
• hyperkalemia—high levels of potassium in the blood.